YOUNG STELLAR OBJECTS IN THE MASSIVE STAR-FORMING REGION W49.

We present the initial results of our investigation of the star-forming complex W49, one of the youngest and most luminous massive star-forming regions in our Galaxy. We used Spitzer/Infrared Array Camera (IRAC) data to investigate massive star formation with the primary objective of locating a representative set of protostars and the clusters of young stars that are forming around them. We present our source catalog with the mosaics from the IRAC data. In this study we used a combination of IRAC, MIPS, Two Micron All Sky Survey, and UKIRT Deep Infrared Sky Survey (UKIDSS) data to identify and classify the young stellar objects (YSOs). We identified 232 Class 0/I YSOs, 907 Class II YSOs, and 74 transition disk candidate objects using color-color and color-magnitude diagrams. In addition, to understand the evolution of star formation in W49, we analyzed the distribution of YSOs in the region to identify clusters using a minimal spanning tree method. The fraction of YSOs that belong to clusters with ⩾7 members is found to be 52% for a cutoff distance of 96″, and the ratio of Class II/I objects is 2.1. We compared the W49 region to the G305 and G333 star-forming regions and concluded that W49 has the richest population, with seven subclusters of YSOs.

ERRATUM: "YOUNG STELLAR OBJECTS IN THE MASSIVE STAR FORMING REGION W49".

[This corrects the article PMC7489494.].

Interim evaluation of the Rural Health Scholars Program.

BACKGROUND: The imperative to address physician maldistribution has been directed in part at medical schools. DESCRIPTION: The Rural Health Scholars Program (RHSP) is an enrichment initiative that has been implemented at 2 medical schools to increase the number of students likely to practice primary care in rural, underserved areas. It is a longitudinal program that includes a skill-building workshop; a 5-week summer preceptorship with community-based preceptors in rural, underserved areas; and opportunities to return to preceptorship sites during 3rd- and 4th-year rotations. Students also attend community-based and teleconference seminars and workshops, as well as informal social gatherings. EVALUATION: A static-group comparison design was used to compare program participants with nonparticipants regarding residency program types and locations. CONCLUSIONS: The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.

Can a 3-day preceptorship change first-year medical students' opinions about living and working in small towns?

BACKGROUND: Research of medical school initiatives that attempt to orient medical students toward rural medicine may facilitate development of initiatives to alleviate physician maldistribution. This study investigated the effect of a 3-day family medicine preceptorship in a small town on first-year medical students' opinions about a) living and working in small towns and b) plans to live in and practice medicine in small towns. Student feedback about the preceptorship was also examined. METHODS: Questionnaires were administered to 137 first-year medical students using a separate sample pretest-posttest design. RESULTS: Student feedback indicated that the preceptorship was a valuable learning experience, but the preceptorship did not appear to influence students' opinions about or interest in living in and working in small towns or rural areas. CONCLUSION: Brief exposure to rural medicine early in the curriculum appears to have little effect on variables that might precede practice location decisions.

Using a standardized family to teach clinical skills to medical students.

BACKGROUND: The use of standardized patients has been an accepted instructional methodology in medical education for many years. A logical evolution of this methodology is the creation of a standardized patient family. DESCRIPTION: This article describes one such standardized family, the Jones family, and how the family is used to teach interpersonal skills, interviewing, communication, counseling, and history-taking skills to medical students. EVALUATION: After several years of using the Jones family, we have found that more comprehensive scripts need to be developed, that recruitment and retention of standardized patients for a year long program does not seem to be a problem, and that the value added by a standardized family greatly enhances the educational experience for students. A standardized family seems a logical educational vehicle for teaching continuity of care, confidentiality, contextual placement of medical information within family dynamics, cultural beliefs, community orientation, and generalism. CONCLUSION: A standardized family is a viable instructional methodology that deserves greater use in medical education.

Are medical students ready to provide HIV-prevention counseling?

PURPOSE: To determine whether medical students were prepared to assess risk and counsel patients about prevention of HIV infection, and whether HIV-related experience produced better knowledge and counseling skills. METHOD: In 1995, students at four North Carolina medical schools interviewed a standardized patient portraying a young woman concerned about HIV infection. The standardized patient recorded whether students asked risk-behavior questions and provided risk-reduction advice. A 21-item questionnaire assessed the students' knowledge of HIV testing and prevention. Students indicated whether they had had experience in educational settings related to HIV or STDs. RESULTS: 415 students completed both the patient interview and the questionnaire. Many failed to ask the patient about several HIV-risk behaviors. Although nearly all (98%) inquired about condom use, fewer than two thirds asked about the patient's history of STDs, number of sexual partners, or specific sexual practices. Most students advised the patient to use condoms. The average score on the knowledge test was 79%; 70% of students confused anonymous with confidential testing, more than half overestimated the risk of HIV transmission from a needle stick, and nearly one in ten did not know how to use a condom. Educational exposures did not produce significantly better risk assessment, counseling information, or knowledge scores. CONCLUSION: A majority of experienced medical students did not assess several important risk factors of a patient concerned about HIV infection, and many would have provided incorrect information related to HIV testing and prevention of infection. Patient contact in traditional clinical settings did not influence prevention knowledge or behavior. More innovative methods are needed to train students in HIV-infection prevention and counseling.

Development of a measure of medical faculty attitudes toward clinical evaluation of students.

PURPOSE: This research involved the development, and in particular the evaluation of the reliability, of scales to measure medical faculty attitudes toward clinical evaluation (ACE) of medical students. The intent was to create measures that yield reliable data and have practical utility in medical education research and faculty development. METHOD: A systematic, eight-step scale development protocol was used to create the instrument. In early 1993 factor analysis was used on data from 217 clinical faculty at four medical schools to refine the measures. Internal consistency and test-retest reliability analyses were performed. Analyses were also done to determine whether the attitude scores were influenced by such faculty demographic attributes as employing medical school, gender, age, tenure track status, academic rank, or academic department. RESULTS: An initial pool of 52 items was reduced to 30 items based on iterative reliability studies. Factor analysis on the 30 items yielded two scales: (1) Quality of Evaluation Procedures, 12 items, alpha = .81; and (2) Content of Departmental Evaluations, eight items, alpha = .85. Test-retest reliabilities (12 weeks) for the scales were .67 and .74, respectively. Faculty demographics did not influence attitudes about the quality of evaluation procedures. However, family physicians showed a slightly more positive attitude toward the content of departmental evaluations than did physicians in five other medical specialties. CONCLUSION: The goal of developing reliable measures of faculty attitudes toward clinical evaluation of medical students has been achieved. With baseline reliabilities established, future research should assess the validity and utility of the scales, especially in the context of clinical practice examinations.

Drug abuse and psychiatric findings in HIV-seropositive pregnant patients.

In a sample of 55 human immunodeficiency virus (HIV)-seropositive pregnant patients, a history of drug abuse was significantly associated with increased psychopathology, particularly depression and personality disorders. Psychiatric disorders preceded the HIV diagnosis in most of the patients studied. Intravenous drug abuse was also associated with increased prostitution, incarceration, and previous suicide attempts. Psychiatric findings were influenced much less by the HIV diagnosis and much more by the presence or absence of a history of drug abuse.

N-acetylcysteine in the treatment of human arsenic poisoning.

A 32-year-old man was brought to the emergency department 5 1/2 hours after ingesting a potentially lethal dose (900 mg) of sodium arsenate ant poison in a suicide attempt. The patient deteriorated progressively for 27 hours. After intramuscular dimercaprol and supportive measures failed to improve his condition, he was given N-acetylcysteine intravenously. The patient showed remarkable clinical improvement during the following 24 hours and was discharged from the hospital several days later.

Throat culture or rapid strep test?

Clearly, rapid tests for streptococci identification are here to stay, and development of the technology is likely to continue. The most rational use of these tests is to identify streptococcal pharyngitis when patients have severe symptoms or when special situations warrant early detection. Throat culture alone is sufficient for most other patients, and all negative rapid tests should be confirmed by throat culture. Specific antistreptococcal therapy should be initiated if either the rapid test or culture is positive. If the physician decides on the basis of clinical criteria to treat pharyngitis with an antibiotic that covers group A beta-hemolytic streptococci, a rapid test is not necessary. If confirmation of the infection is warranted in these cases, throat culture alone should suffice. No rapid strep test kit clearly outperforms others. With any test, good results depend on the quality of the specimen.

Chancroid.

Although chancroid is still one of the minor sexually transmitted diseases in the United States, the incidence has increased, with over 3000 cases in 1986. Cases have been reported in 21 states, primarily among black and Hispanic heterosexual men. Patients may be asymptomatic, but frequently both primary and secondary sexual contacts have ulcers. Because confirmation of the diagnosis requires special laboratory conditions, diagnosis usually is based on characteristics of the lesions. Chancroid can be confused with other more common diseases, particularly genital herpes. Differential characteristics are incubation period, location and appearance of lesions, and the presence or absence of associated lymphadenopathy. A simple regimen of antibiotic therapy is highly effective, but control of outbreaks requires prompt identification, treatment of a patient's sexual contacts, and patient education about prevention.

Influence of pentoxifylline on steady-state theophylline serum concentrations from sustained-release formulations.

This clinical study assessed the influence of pentoxifylline and its metabolites on steady-state serum theophylline concentrations. Nine healthy volunteers took sustained-release formulations of pentoxifylline, theophylline, and a combination of both agents each for 7 days at standard therapeutic doses in a randomized order. Serum theophylline concentrations were analyzed using fluorescence-polarization immunoassay (TDx) technique. During the pentoxifylline treatment phase, serum theophylline concentrations were undetectable, demonstrating the lack of assay interference from pentoxifylline and its metabolites. Mean trough steady-state serum theophylline concentrations were 30% higher (p less than 0.05) during the combination treatment phase compared to theophylline administration alone, and varied considerably. Although side effects were more frequent during the combination phase, differences in the number of adverse reactions did not achieve statistical significance. This study demonstrates an interaction between theophylline and pentoxifylline, and indicates that close monitoring of serum theophylline concentrations during combination therapy is warranted.

Reversible cardiomyopathy due to selenium deficiency.

Selenium is an essential trace element and a component of glutathione peroxidase, an enzyme that may help to prevent oxidative damage to cells. Selenium deficiency has been linked to the development of Keshan disease, a dilated congestive cardiomyopathy occurring primarily in children living in rural China. Sporadic cases have been reported in the United States in individuals with poor nutritional intake, mostly in individuals on long-term home parenteral nutrition. This report describes a young black woman with Crohn's disease in whom a congestive cardiomyopathy developed and was subsequently reversed following administration of selenium.

Whole blood platelet aggregation in dogs with liver disease.

Whole blood platelet aggregation was determined in response to collagen, arachidonic acid, and adenosine diphosphate in 20 dogs with liver disease and in 20 control dogs. Platelet aggregation in response to collagen and arachidonic acid was reduced in dogs with liver disease, compared with control dogs (P less than 0.05), whereas there was no significant difference in platelet response to adenosine diphosphate between the 2 groups of dogs. Adenosine diphosphate was found not to be a reliable aggregation agent for determination of whole blood platelet aggregation in dogs. Dogs whose platelets did not aggregate in response to collagen and/or arachidonic acid manifested bleeding tendencies that could be attributed to platelet dysfunction.